Project Summary Socioeconomic disparities in chronic diseases shown to emerge in childhood such as asthma, obesity and hypertension are well-documented, warranting further investigation into the contribution of socioeconomic disadvantage (SD) during the prenatal period to fetal programming of biologic processes involved in the etiology of these conditions. Inflammation has been identified as a key factor in the etiology of several childhood chronic diseases and a recent study demonstrated that individuals born to mothers that experience greater socioeconomic disadvantage (SD) during pregnancy have elevated inflammation in adulthood, controlling for postnatal factors, suggesting that SD during the prenatal period may play an important role in fetal programming of a pro-inflammatory phenotype that predisposes children to the onset of chronic diseases shown to emerge in childhood. Whether maternal SD is associated with elevated inflammatory response in children at birth and the biologic pathways by which immune programming may occur remain, however, unclear. A wealth of studies have also demonstrated strong socioeconomic gradients in adverse birth outcomes, such as preterm and small for gestational age (SGA) births, which have also been linked to onset of chronic diseases with inflammation-related etiology, warranting further investigation of the role that adverse birth outcomes may play in programming a pro-inflammatory phenotype in children born into low socioeconomic environments. We take advantage of the unprecedented opportunity to link live birth registry and census data on SD experienced during pregnancy among the mothers of population-based sample of 1000 (singleton-birth) children born in Michigan from April 2009-March 2010 to their residual neonatal bloodspots archived in the Michigan Neonatal Biobank that can be tested for markers of elevated inflammatory response at birth. The aims of this proposal are (1) to assess whether maternal SD during pregnancy is associated with a pro-inflammatory phenotype in children at birth, (2) examine whether this association is mediated by adverse birth outcomes and, (3) identify whether offspring sex modifies these relationships.